Intramedullary Nail With Oblique Openings

ABSTRACT

An intramedullary nail for use in a medullary canal of a long bone. The nail includes a body defining a longitudinal axis and an external periphery for fitting in the medullary canal of the long bone. The body has a first internal wall thereof defining a first opening through the body, defining a first opening centerline. The body has a second internal wall defining a second opening through the body, defining a second opening centerline. The first opening centerline and the second opening centerline are oblique with respect to each other. The longitudinal axis of the body and the first opening centerline form an acute angle between the longitudinal axis of the body and the first opening centerline. The longitudinal axis of the body and the second opening centerline forming an acute angle between the longitudinal axis of the body and the second opening centerline.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.12/542,011 filed on Aug. 17, 2009, which is a divisional of U.S. patentapplication Ser. No. 11/262,654 filed on Oct. 31, 2005, now abandoned.The entire disclosures of each of the above applications areincorporated herein by reference in their entirety.

FIELD

The present disclosure relates generally to the field of orthopaedics,and more particularly, to a device for securing a prosthetic componentto bone for use with orthopaedic trauma or orthopaedic joint products.

BACKGROUND

The skeletal system includes many long bones that extend from the humantorso. These long bones include the femur, fibula, tibia, humerus,radius and ulna. These long bones particularly are exposed to traumafrom accidents, and as such often are fractured during such trauma andmay be subject to complex devastating fractures.

Automobile accidents, for instance, are a common cause of trauma to longbones. In particular, the femur and tibia frequently fracture when thearea around the knee is subjected to a frontal automobile accident.

Often the distal end or proximal portions of the long bone, for examplethe femur and the tibia, are fractured into several components and mustbe realigned. Mechanical devices, commonly in the forms of pins, plates,screws, nails, wires and external devices are commonly used to attachfractured long bones. The pins, plates, wires, nails and screws aretypically made of a durable material compatible to the human body, forexample titanium, stainless steel or cobalt chromium.

Fractures of the long bone are typically secured into position by atleast one of three possible techniques or methods.

The first method is the use of intramedullary nails that are positionedin the intramedullary canal of those portions of the fractured bone.

A second method of repairing fractured bones is the use of internal boneplates that are positioned under the soft tissue and on the exterior ofthe bone and that bridge the fractured portion of the bone.

Another method of securing fractured bones in position is the use ofexternal fixators. These external fixators have at least two generalcategories. In one category, the fixator is generally linear, with afirst portion of the fixator to connect to a first fracture segment ofthe bone and a second fracture segment of the fixator to connect to asecond fracture segment of the bone. A first series of bone screws orpins are first connected to the fixator and then to the first fracturesegment of the bone. Then a second series of screws or pins areconnected to the fixator and then to the second fracture segment of thebone, thereby securing the first fracture segment of the bone to thesecond fracture segment of the bone.

A second method of external fixation is through the use of a ring typefixator that uses a series of spaced-apart rings to secure the bone. Forexample, an upper ring and a lower ring are spaced apart by rods. Aplurality of wires is placed through the long bone and connected on eachend of the long bone by the ring. The wires are then tensioned much as aspoke in a bicycle are tightened, thereby providing for a rigidstructure to support the first fracture segment portion of the bone.Similarly, a plurality of wires are positioned through the secondfracture segment of the bone and are secured to and tensioned by thelower ring to provide a rigid fixation of the second fracture segment ofthe bone bridging the fracture site.

There are a variety of devices used to treat femoral fractures.Fractures of the neck, head or intertrochanter of the femur have beensuccessfully treated with a variety of compression screw assemblieswhich include a compression plate having a barrel member, a lag screwand a compressing screw. The compression plate is secured to theexterior of the femur and the barrel member is inserted into apredrilled hole in the direction of the femoral head.

The lag screw which has a threaded end and a smooth portion is insertedthrough the barrel member so that it extends across the break and intothe femoral head. The threaded portion engages the femoral head. Thecompressing screw connects the lag screw to the plate. By adjusting thetension of the compressing screw the compression (reduction) of thefracture can be adjusted. The smooth portion of the lag screw must befree to slide through the barrel member to permit the adjustment of thecompression screw.

Subtrochanteric and femoral shaft fractures have been treated with thehelp of intramedullary rods, which are inserted into the marrow canal ofthe femur to immobilize the femoral parts involved in fractures. Asingle angled cross-nail or locking screw is inserted through the femurand into the proximal end of the intramedullary rod. In some varieties,one or two screws may also be inserted through the femoral shaft andthrough the distal end of the intramedullary rod. These standardintramedullary rods have been successfully employed in treatingfractures in lower portions of the femoral shaft.

Trochanteric nails for use in preparing femoral neck fractures utilize ascrew in the form of, for example, a lag screw. The lag screws haveseveral different problems in use that are generally related to the lagscrew not remaining in the proper position with respect to theintramedullary nail during the operating life of an implant. Forexample, the lag screw may cut proximally through the femoral neck andhead, causing the neck and head to move out of its operating position incooperation with the acetabulum. Such a movement may render the patientnon-ambulatory. Another issue that may occur with lag screws is medialmigration of a lag screw through the femoral head and into the pelviccavity. A further issue with an intramedullary nail lag screw is lateralmigration or lateral pullout of the screw from the long bone.

Yet another problem with lag screws in trochanteric nail applications isthe problem of neck collapse. Early after the implantation of thetrochanteric nail, for example, at the first weight-bearing instance ofthe patient, the head of the femur may move distally due to a phenomenonknown as neck collapse. If the lag screw does not capture enoughcancellous bone in the femoral neck, the neck and head may movelaterally causing the phenomenon known as neck collapse and creating aleg length and other issues for the patient.

Medial migration is only one of many problems that occur with a fastenerfor use with orthopaedic prosthetic components. The design of fastenersin cancellous and/or osteoporotic bone must deal with parameters such aspull-out forces, installation torque requirements, stripping of thebone, migration and others.

The proximal femoral fractures, for example, those around the lessertrochanter, greater trochanter, and femoral neck have been successfultreated with a variety of compression screw assemblies andintramedullary rods. The intramedullary rods are inserted into thenarrow canal of the femur to immobilize the femur parts involved in thefracture. Typically, a single screw is inserted through the femur andthe proximal end of the intramedullary rod. Alternatively, a secondscrew may be inserted through the femur and into the proximal end of theintramedullary rod to prevent rotation of, for example, the neck andhead of the femur.

One of the earliest intramedullary devices introduced in the UnitedStates was the Grosse-Kempf nail manufactured by Howmedica Company ofRotherudge, N.J. The Grosse-Kempf nail includes a threaded hole in theintramedullary rod for receiving an interlocking screw. The fullythreaded screw cannot freely slide in order to permit the compressionfound in typical compression screw assemblies.

Another prior art device is in the form of Zickel™ nail (U.S. Pat. No.3,433,220). The Zickel nail is a solid intramedullary nail having asingle proximal tri-flangle cross-nail which is inserted into thedirection of the femoral head. The solid cross-section does not permitthe nail to be introduced over a guide rod. Thus, the nail is preventedfrom being used for comminuted and distal fractures of the femur becausethe closed surgical technique cannot be practiced. In addition, adequatecompression cannot be achieved due to the requirement to lockcross-nail.

Yet another prior art device is in the form of the Russell-Taylor™interlocking nail manufactured by Richards Medical Company of Memphis,now Smith, Nephew, and Richards. The Russell-Taylor nail similarlyrequires a fully threaded locking screw and therefore does not permitsliding of the screw relative to the intramedullary rod.

Yet a further prior art device is in the form of the Gamma™ nail ismanufactured by Stryker-Howmedica. The Gamma nail provides for slidingcompression of the lag screw through the use of a smooth shaft. TheGamma nail stops rotation of the lag screw by means of a set screwthrough the proximal portion of the intramedullary nail.

A further prior art device in the form of the Ace Trochanteric™ nailmanufactured by DePuy Orthopaedics, Inc. provides for means of stoppingrotation of the femoral head in an unstable fracture pattern by the useof a second threaded screw in the femoral head. The lag screw ispermitted to rotate freely within the nail.

In unstable femur fractures, stability is necessary to facilitate properhealing of the bone. The femur fractures may be a greater trochantericto lesser trochanteric fracture, or a fracture of, for example, the neckof the femur. In compound fractures, the bone may be fractured at morethan one fracture site. Such multiple fractures are instable and theproper healing of such fractures is difficult. Axial and rotationalstability of such fractures may also be an issue. The present inventionis an attempt to address at least some of the aforementioned issues.

The present invention is directed to alleviate at some of theaforementioned concerns with orthopaedic fasteners.

SUMMARY

An embodiment of the present invention is in the form of anintramedullary nail containing a series of holes that allows for lockingscrews to be placed in various positions. The nail can be locked using acombination of screws, which allows various locking constructions. Thenail of the present invention allows two separate screws to be placedthrough the nail, each screw in one of two different planes. The abilityto use multiple screws in different planes allows better stability to beachieved with the locking screws.

The intramedullary nail of the present invention may be in the form of aTrochanteric Entry Nail (“TEN Nail”) design allowing for multiple screwfixation to be achieved in opposing planes for better fracturestabilization. As an alternative to this design, the Trochanteric EntryNail may be adapted for use with two screws that are located in the sameplane and extend into the femoral neck. In unstable femoral fractures,stability is necessary to facilitate the proper healing and the TEN Naildesign of the present invention accomplishes the improved stability. Inaddition to using multiple planes, the screw creates a triangulargeometry that aids in better axial and rotational stability.

According to the present invention, an intramedullary nail is providedwith two transverse holes for reconstruction screws and an angulatedcrossing hole for a trochanteric screw that goes from the greatertrochanter to the lesser trochanter regions of the femur for lockingscrew placement. The locking screws are placed through the nail in acombination in ways that, if one reconstruction screw and thetrochanteric screw are utilized, an (X) shape appears in the medial tolateral plane. When this two-screw construction is observed down theaxis of the nail, the screws have an (X) appearance. The opposing natureof the screw in this nail configuration gives the added stability thatis desired for this type of fracture repair. The screw configuration canbe changed, so that a combination of one or two screws can be useddepending on the fixation that is desired based on a particular fracturepattern.

According to one embodiment of the present invention, there is providedan intramedullary nail for use in a medullary canal of a long bone. Thenail includes a body defining a longitudinal axis and an externalperiphery of the body for fitting in the medullary canal of the longbone. The body has a first internal wall of the body defining a firstopening through the body. The first opening defines a first openingcenterline. The body has a second internal wall of the body defining asecond opening through the body. The second opening defines a secondopening centerline. The first opening centerline and the second openingcenterline are oblique with respect to each other. The first openingcenterline and the longitudinal axis of the body form an acute anglebetween the first opening centerline and the longitudinal axis.

According to another embodiment of the present invention there isprovided an intramedullary nail assembly for use in a medullary canal ofa long bone. The nail assembly includes a nail defining a longitudinalaxis and an external periphery of the nail for fitting in the medullarycanal of the long bone. The nail has a first internal wall of the naildefining a first opening through the nail. The first opening defines afirst opening centerline. The nail has a second internal wall of thenail defining a second opening through the nail. The second openingdefines a second opening centerline. The first opening centerline andthe second opening centerline are oblique with respect to each other.The first opening centerline and the longitudinal axis of the body forman acute angle between the first opening centerline and the longitudinalaxis. The nail assembly also includes a first screw slidably fitted tothe first opening and a second screw slidably fitted to the secondopening.

According to yet another embodiment of the present invention there isprovided a method for performing trauma surgery on a long bone. Themethod includes the step of providing an intramedullary nail. The naildefines a longitudinal axis and an external periphery of the nail forfitting in the medullary canal of the long bone. The nail has a firstinternal wall of the nail defining a first opening through the nail. Thefirst opening defines a first opening centerline. The nail has a secondinternal wall of the nail defining a second opening through the nail.The second opening defines a second opening centerline. The firstopening centerline and the second opening centerline are oblique withrespect to each other. The first opening centerline and the longitudinalaxis of the body form an acute angle between the first openingcenterline and the longitudinal axis.

The method also includes the steps of positioning the nail at leastpartially in the medullary canal and providing a first screw forcooperation with the long bone and for sliding cooperation with thefirst opening in the nail. The method also includes the steps ofinserting the first screw through the cortical wall of the lessertrochanter of the long bone and inserting the first screw through thefirst opening. The method also includes the steps of inserting saidfirst screw through the cortical wall of the greater trochanter of thelong bone and providing a second screw for cooperation with the longbone and for sliding cooperation with the second opening in the nail.The method further includes the steps of inserting the second screwthrough the cortical wall of the long bone, inserting the second screwthrough the second opening, and inserting the second screw through thecortical wall of the long bone.

According to another embodiment of the present invention there isprovided an intramedullary nail for use in a medullary canal of a longbone. The nail includes a body defining a longitudinal axis of the bodyand an external periphery of the body for fitting in the medullary canalof the long bone. The body has a first internal wall thereof defining afirst opening through the body. The first opening defines a firstopening centerline.

The body has a second internal wall of the body defining a secondopening through the body. The second opening defines a second openingcenterline. The first opening centerline and the second openingcenterline are oblique with respect to each other. The longitudinal axisof the body and the first opening centerline form an acute angle betweenthe longitudinal axis of the body and the first opening centerline. Thelongitudinal axis of the body and the second opening centerline formingan acute angle between the longitudinal axis of the body and the secondopening centerline.

According to yet another embodiment of the present invention there isprovided a kit for use in repairing a fracture in a long bone. The kitincludes a nail adapted for implantation in a medullary canal of thelong bone. The nail defines a longitudinal axis and an externalperiphery of the nail for fitting in the medullary canal of the longbone. The nail has a first internal wall thereof defining a firstopening through the nail. The first opening defines a first openingcenterline. The nail has a second internal wall of the nail defining asecond opening through the nail. The second opening defines a secondopening centerline. The first opening centerline and the second openingcenterline are oblique with respect to each other. The longitudinal axisof the body and the first opening centerline form an acute angle betweenthe longitudinal axis of the body and the first opening centerline. Thelongitudinal axis of said body and the second opening centerline form anacute angle between the longitudinal axis of the body and the secondopening centerline. The kit also includes a first screw adapted to beslidably fitted with the first opening and a second screw adapted to beslidably fitted with the second opening.

According to another embodiment of the present invention there isprovided a method for performing trauma surgery on a long bone. Themethod includes the step of providing an intramedullary nail. The naildefines a longitudinal axis and an external periphery of the nail forfitting in the medullary canal of the long bone. The nail has a firstinternal wall of the nail defining a first opening through the nail. Thefirst opening defines a first opening centerline.

The nail has a second internal wall, which defines a second openingthrough the nail. This second opening defines a second openingcenterline. The first and the second opening centerlines are obliquewith respect to each other. At least one of the first opening centerlineand the second opening centerline are transverse to the longitudinalaxis of the nail. The longitudinal axis of the body and the firstopening centerline form an acute angle between the longitudinal axis ofthe body and the first opening centerline. The longitudinal axis of thebody and the second opening centerline forming an acute angle betweenthe longitudinal axis of the body and the second opening centerline.

The method also includes the steps of positioning the nail at leastpartially in the medullary canal and providing a first screw forcooperation with the long bone and for sliding cooperation with thefirst opening in the nail. The method also includes the steps ofinserting the first screw through the cortical wall of the lessertrochanter of the long bone and inserting the first screw through thefirst opening.

The method also includes the steps of inserting the first screw throughthe cortical wall of the greater trochanter of the long bone andproviding a second screw for cooperation with the long bone and forsliding cooperation with the second opening in the nail. The method alsoincludes the steps of inserting the second screw through the corticalwall of the long bone and inserting the second screw through the secondopening. The method also includes the step of inserting the second screwthrough the cortical wall of the long bone.

The technical advantages of the present invention include the ability toprovide locking screws in various positions in an intramedullary nail.For example, according to one aspect of the present invention, anintramedullary nail for use in a medullary canal of a long bone isprovided. The nail includes a body defining a longitudinal axis and anexternal periphery for fitting in the medullary canal of the long bone.The body defines a plurality of internal walls for defining a pluralityof openings through the nail. Thus, the present invention provides forthe ability to provide locking screws in various positions in that thelocking screw can be placed in each of the openings.

The technical advantages of the present invention further include theability to allow two separate screws to be placed at one time in one ortwo different planes. For example, and according to another aspect ofthe present invention, an intramedullary nail for use in the medullarycanal of a long bone is provided. The nail includes a body defining alongitudinal axis and an external periphery for fitting in the canal ofthe long bone. The body has a first internal wall defining a firstopening and a second internal wall defining a second opening. The secondopening defines a second opening centerline and the first openingdefines a first opening centerline. The first opening centerline and thesecond opening centerline are oblique with respect to each other. Thus,the present invention provides for the ability to allow two separatescrews, one in each of the two openings, to be placed at one time in oneor two different planes.

The technical advantages of the present invention also include theability to allow for multiple screw fixations to be achieved in opposingplanes for better fracture stabilization. For example, according to yetanother aspect of the present invention, an intramedullary nail for usein the canal of a long bone is provided. The nail includes a bodydefining a longitudinal axis and an exterior periphery. The body has afirst internal wall defining a first opening and a first openingcenterline. The body also has a second internal wall defining a secondopening having a second opening centerline. The first opening centerlineand the second opening centerline are oblique with respect to eachother. Each of the first opening and the second opening are adapted forreceiving a screw. Thus the present invention provides for multiplescrew fixation to be achieved in opposing planes for better fracturestabilization.

The technical advantages of the present invention also include theability to place two screws in the same plane of the femoral neck. Forexample, according to yet another aspect of the present invention, anintramedullary nail is provided including a body defining a longitudinalaxis and an extended periphery. The body includes a first internal walldefining a first opening and a second internal wall defining a secondopening spaced from the first opening. The first opening and the secondopening are parallel and spaced apart and are positioned such that theopenings may be in alignment with the femoral neck of the patient. Theopenings may be adapted for receiving spaced apart screws that may befitted into the neck of the femur. Thus, the present invention providesfor two screws in the same plane of the femoral neck.

The technical advantages of the present invention also include theability to place screws in multiple planes to treat unstable femoralfractures. For example, according to yet another aspect of the presentinvention, an intramedullary nail assembly is provided including a naildefining a longitudinal axis and an external periphery. The nailincludes a first opening defining a first opening centerline and asecond opening defining a second opening centerline. The first openingcenterline and the second opening centerline are oblique. Each of thefirst opening and the second opening are adapted for receiving screws.Thus, the present invention provides for a nail in which screws may beplaced in multiple planes to treat unstable femoral fractures.

The technical advantages of the present invention also include theability to use two screws that may provide for an x-shaped geometry thataids in better axial and rotational stability. For example, according toyet another aspect of the present invention, an intramedullary nailassembly is provided, including a nail having a first opening as well asa spaced-apart second opening. The first opening and the second openingare oblique with respect to each other. The first opening and the secondopening define generally an x-shape. Each of the two openings mayreceive a screw. Thus the present invention provides for the use of twoscrews to provide an x-shaped geometry that aids in better axial androtational stability.

The technical advantages of the present invention also include theability to permit trochanteric to greater trochanteric as well asfemoral neck fixation with the same nail. For example, according to yetanother aspect of the present invention, an intramedullary nail assemblyis provided including a nail, that has a first opening along a firstaxis and a second opening along a second axis. The first and second axesare oblique and the first axis is in alignment with the greatertrochanter and the lesser trochanter, while the second centerline is inalignment with the femoral neck of the femur. Each of the first andsecond openings are adapted for receiving screws. Thus the presentinvention provides for greater trochanteric to lesser trochanteric bonefixation and femoral neck fixation within the same nail.

Other technical advantages of the present disclosure will be readilyapparent to one skilled in the art from the following figures,descriptions and claims.

DRAWINGS

FIG. 1 is a partial anterior/posterior view of a intramedullary nailassembly in accordance with an embodiment of the present invention inthe form of a left femoral trochanteric nail assembly implanted in aleft femur;

FIG. 1A is an end view of the nail assembly of FIG. 1 showing theangular relationship of the screws;

FIG. 1B is a perspective view generally from the proximal end of thenail of FIG. 1 showing the screws intersecting the nail;

FIG. 2 is an anterior/posterior view of the intramedullary nail of theintramedullary nail assembly of FIG. 1;

FIG. 3 is a medial/lateral view of the intramedullary nail of FIG. 2;

FIG. 3A is an enlarged medial/lateral view of the distal tip of the nailof FIG. 3 showing the chamfer in greater detail;

FIG. 3B is an enlarged anterior/posterior view of the distal tip of thenail of FIG. 3 showing the chamfer in greater detail;

FIG. 4 is an enlarged partial anterior/posterior view partially in crosssection of the proximal end of the intramedullary nail assembly of theintramedullary nail of FIG. 2;

FIG. 5 is an enlarged partial anterior/posterior view of the proximalend of the intramedullary nail assembly of FIG. 1 implanted in a leftfemur with only the greater trochanter/lesser trochanter screw in use;

FIG. 6 is an enlarged partial anterior/posterior view of the proximalend of the intramedullary nail assembly of FIG. 1 implanted in a leftfemur with two fully threaded femoral neck screws in use;

FIG. 7 is an enlarged partial anterior/posterior view of the proximalend of the intramedullary nail assembly of FIG. 1 implanted in a leftfemur with two partially threaded femoral neck screws in use;

FIG. 8 is an enlarged partial anterior/posterior view of the proximalend of the intramedullary nail of FIG. 1 implanted in a left femur witha fully threaded femoral neck screws and a partially threaded femoralneck screws in use;

FIG. 9 is a plan view of a cortical screw for use in the nail assemblyof FIG. 1;

FIG. 9A is a plan view of a first distal cortical screw for use in thenail assembly of FIG. 1;

FIG. 9B is a plan view of a second distal cortical screw for use in thenail assembly of FIG. 1;

FIG. 10 is a plan view of a first cancellous screw for use in the nailassembly of FIG. 1;

FIG. 10A is a plan view of a second cancellous screw for use in the nailassembly of FIG. 1;

FIG. 11 is an anterior/posterior view of an intramedullary nail inaccordance with an embodiment of the present invention in the form of aright femoral trochanteric nail implanted in a right femur;

FIG. 12 is a medial/lateral view of the intramedullary nail of FIG. 11;

FIG. 12A is a partial medial/lateral view of the elongated slot of theintramedullary nail of FIG. 12;

FIG. 13 is a partial anterior/posterior view of the intramedullary nailof FIG. 11;

FIG. 14 is an enlarged partial anterior/posterior view of the proximalend of the intramedullary nail of FIG. 11 implanted in a right femurwith only a greater trochanter/lesser trochanter screw in use to form anail assembly according to the present invention;

FIG. 15 is an enlarged partial anterior/posterior view of the proximalend of the intramedullary nail of FIG. 11 implanted in a right femurwith a greater trochanter/lesser trochanter screw and a partiallythreaded femoral neck screw in use to form a nail assembly according tothe present invention;

FIG. 16 is an enlarged partial anterior/posterior view of the proximalend of the intramedullary nail of FIG. 11 implanted in a right femurwith two partially threaded femoral neck screws in use;

FIG. 17 is a partial anterior/posterior view of a intramedullary nailassembly in accordance with another embodiment of the present inventionin the form of a left femoral trochanteric nail with two partiallythreaded femoral neck screws, one being a cannulated lag screw in use toform a nail assembly implanted in a left femur;

FIG. 17A is an end view of the nail assembly of FIG. 17 showing theangular relationships of the screws;

FIG. 18 is an anterior/posterior view of the intramedullary nail of theintramedullary nail assembly of FIG. 17;

FIG. 19 is a medial/lateral view of the intramedullary nail of FIG. 18;

FIG. 20 is an plan view of a lag screw for use in the nail assembly ofFIG. 17;

FIG. 21 is a cross sectional view of the lag screw of FIG. 20 along theline 21-21 in the direction of the arrows;

FIG. 22 is a partial view of a box type form for an alternate lag screwfor use with an alternate embodiment of the intramedullary nail assemblyof the present invention;

FIG. 22A is a partial view of a standard thread form for an alternatelag screw for use with an alternate embodiment of the intramedullarynail assembly of the present invention;

FIG. 22B is a partial view of a V-shaped thread form for an alternatelag screw for use with an alternate embodiment of the intramedullarynail assembly of the present invention;

FIG. 22C is a partial view of a square-shaped thread form for analternate lag screw for use with an alternate embodiment of theintramedullary nail assembly of the present invention;

FIG. 22D is a partial view of a truncated V-shaped thread form for analternate lag screw for use with an alternate embodiment of theintramedullary nail assembly of the present invention;

FIG. 22E is a partial view of a reverse box thread form for an alternatelag screw for use with an alternate embodiment of the intramedullarynail assembly of the present invention;

FIG. 23 is an enlarged cross-sectional view of the box shaped thread ofthe screw of FIG. 22;

FIG. 24 is an anterior/posterior view of an intramedullary nail inaccordance with an embodiment of the present invention in the form of aright femoral trochanteric nail implanted in a right femur;

FIG. 25 is a medial/lateral view of the intramedullary nail of FIG. 24;

FIG. 26 is an enlarged partial anterior/posterior view of the proximalend of the intramedullary nail of FIG. 11 implanted in a right femurwith a greater trochanter/lesser trochanter screw and a femoral neckscrew in use to form a nail assembly according to another embodiment ofthe present invention;

FIG. 27 is a partial anterior/posterior view of a intramedullary nailassembly in accordance with another embodiment of the present inventionin the form of a left femoral trochanteric nail with two partiallythreaded femoral neck screws, one being a cannulated lag screw in use toform a nail assembly implanted in a left femur with a piriforma fossaentry;

FIG. 27A is an end view of the nail assembly of FIG. 27 showing theangular relationships of the screws;

FIG. 28 is an anterior/posterior view of the intramedullary nail of theintramedullary nail assembly of FIG. 27;

FIG. 29 is a medial/lateral view of the intramedullary nail of FIG. 28;

FIG. 29A is an enlarged medial/lateral view of the distal tip of thenail of FIG. 29 showing the chamfer in greater detail;

FIG. 29B is an enlarged anterior/posterior view of the distal tip of thenail of FIG. 29 showing the chamfer in greater detail;

FIG. 30 is an anterior/posterior view of an intramedullary nail inaccordance with an embodiment of the present invention in the form of aright femoral trochanteric nail implanted in a right femur with apiriforma fossa entry;

FIG. 31 is a medial/lateral view of the intramedullary nail of FIG. 30;

FIG. 32 is an enlarged partial anterior/posterior view of the proximalend of the intramedullary nail of FIG. 30 implanted in a right femurwith a greater trochanter/lesser trochanter screw and a femoral neckscrew in use to form a nail assembly according to another embodiment ofthe present invention;

FIG. 33 is a plan view of a kit for use in performing trauma surgery inaccordance with yet another embodiment of the present;

FIG. 34 is a first portion flow diagram of a method of performing traumasurgery in accordance with another embodiment of the present;

FIG. 34A is a second portion of the flow diagram of FIG. 34;

FIG. 35 is a first portion flow diagram of a method of performing traumasurgery in accordance with yet another embodiment of the present; and

FIG. 35A is a second portion of the flow diagram of FIG. 35.

Corresponding reference characters indicate corresponding partsthroughout the several views. Like reference characters tend to indicatelike parts throughout the several views.

DETAILED DESCRIPTION

Embodiments of the present invention and the advantages thereof are bestunderstood by referring to the following descriptions and drawings,wherein like numerals are used for like and corresponding parts of thedrawings.

According to the present invention and referring now to FIG. 1, a firstembodiment of the present invention is shown as intramedullary nailassembly 10. Intramedullary nail assembly 10 is used in a medullarycanal 2 of a long bone 4. The nail assembly 10 includes a nail 20. Thenail 20 defines a longitudinal axis 22 of the nail 20. The nail 20further includes an external periphery 24 of the nail 20. The externalperiphery 24 of the nail 20 is adapted for fitting in the medullarycanal 2 of the long bone 4. The long bone 4 may be any long bone in thehuman anatomy. For example, the long bone 4 may be a femur, a tibia, ahumerus, or any other long bone. Preferably, the long bone in which thenail of the present invention is used is a humerus, a femur, or a tibia,where the canal of the bone is large enough to receive a nail of thetype of the present invention.

The nail 20 defines a first internal wall 26 of the nail 20. Theinternal wall 26 defines a first opening 28 through the nail 20. Itshould be appreciated that if the nail 20 is solid, the opening 28passes obliquely through the nail 20. It should likewise be appreciatedthat if the nail 20 has a longitudinal opening or is cannulated, theopening 28 passes through both the external walls of the nail.

The nail 20 as shown in FIG. 1, further includes or defines a secondinternal wall 30 of the nail 20. The second internal wall 30 defines asecond opening 32 through the wall 30 of the nail 20. The first opening28 defines a first opening centerline 34. The second opening 32 definesa second opening centerline 36.

According to the present invention, the first opening centerline 34 andthe second opening centerline 36 are oblique. The first openingcenterline 34 and the second opening centerline 36, as is shown in FIG.1, do not intersect and are not coplanar.

The nail assembly 10 of the present invention further includes a firstscrew 38. The first screw 38 includes a shank portion 40 that isslidably fitted to the first opening 28.

As shown in FIG. 1, the first screw 38 extends from greater trochanter44 through cortical bone 6 into the first opening 28 into cancellousbone 8 and into cortical bone 6 and then to the lesser trochanter 46. Asshown in FIG. 1, head 42 of the first screw 38 rests against thecortical bone 6 of the greater trochanter 44. The shank portion 40 ofthe first screw 38 engages cortical bone 6 around the lesser trochanter46.

As shown in FIG. 1, the nail 10 includes a proximal portion 48 and adistal portion 50. As can be seen in FIG. 1, the nail 10 may, if it isstraight or linear, enter the long bone or femur 4 through piriforma 52.If, however as shown in FIG. 1, the nail 20 is in the form of a bent ortrochanteric nail, the nail 20 is installed or placed in the long bone 4through the greater trochanter 44. Since the greater trochanter 44 isnot in alignment with the centerline of the canal 2 of the femur 4, theproximal portion 48 of the nail 20 is bent and forms an angle β betweenlongitudinal centerline 56 of the distal portion 50 of the nail 20 andlongitudinal centerline 54 of the proximal portion 48 of the nail 20.

The first opening centerline 34 of the first opening 28 forms an angle θbetween the first opening centerline 34 and longitudinal centerline 54of the proximal portion 48 of the nail 20. The angle θ is chosen suchthat the first screw 38 may extend from greater trochanter 44 to lessertrochanter 46.

The nail assembly 10 of the present invention further includes a secondscrew 58. The second screw 58 is adapted to be fitted into the secondopening 32 of the nail 20. The second screw 58, similar to the firstscrew 38, includes a shank 60 and a head 62. The shank 60 extends intothe second opening 32. The shank 60 of the second screw 58 may includecancellous threads 64 for engaging with cancellous bone 8.

The second opening centerline 36 forms an angle α with respect to thelongitudinal centerline 54 of the proximal portion 48 of the nail 20.The angle α is chosen such that the second screw 58 may extend into neck3 and head 5 of the femur or long bone 4. The head 62 of the secondscrew 58 rests upon the exterior wall of the long bone 4 and the shank60 of the second screw 58 extends through cortical 6, cancellous bone 8,the second opening 32, additional cancellous bone 8, through the neck 3,and into the head 5 of the femur or long bone 4.

The nail 20 may be solid or may include a central opening or cannula 66.Nail 20 may also include a third opening 68 formed in the nail 20. Thethird opening 68 may define a third opening longitudinal centerline 70.The third opening 68 may, as shown in FIG. 1, be parallel to the secondopening 32. Thus, the second opening centerline 36 and the third openingcenterline 70 may be parallel to each other.

The proximal portion 48 of the nail 20 may be larger in cross sectionthan the distal portion 50 in that the proximal portion 48 of the nail20 is adapted for positioning in the larger condylar portion of thefemur 4.

As shown in FIG. 1, the nail assembly 10 is for use with a left femur.It should be appreciated that the nail 20 may be utilized with a rightfemur. Nail 20 includes additional bone conforming features that makethe nail 20 particularly compatible with a left femur.

Referring now to FIG. 1A, the positioning of the first opening 28, thesecond opening 32 and the third opening 68 are shown in greater detail.The first centerline 34 of the first opening 28 defines a first plane72. As shown in FIG. 1A, the first plane 72 is coincident withlongitudinal centerline 54 of the proximal portion 48 of the nail 20. Itshould be appreciated that the first plane 72 may be positionedelsewhere than the longitudinal centerline of the proximal portion ofthe nail.

As shown in FIG. 1A, the second centerline 36 of the second opening 32and the third centerline 70 of the third opening 68 define second plane74. The second plane 74 is shown in FIG. 1A is coincident withlongitudinal centerline 54 of the proximal portion 48 of the nail 20.The first plane 72 and the second plane 74 define an angle σ formedthere between. The angle σ as shown in FIG. 1A may be an acute angle.For example, the angle σ may be from about 10 degrees to 45 degrees.

Referring again to FIG. 1, it should be appreciated that with the firstscrew 38 positioned in the first opening 28 and the second screw 58positioned in the second opening 32, a generally x-shaped configurationis provided by the first screw 38 and the second screw 58. The x-shapedscrew configuration of FIG. 1 provides for the strength and stabilitythat may be desired when repairing a femoral fracture.

Referring now to FIG. 1B, the nail assembly 10 is shown with the firstscrew 38 and the second screw 58 intersecting the nail.

Referring now to FIG. 2, the nail 20 of the present invention is shownwith the full distal portion 50 shown. The distal portion 50 of the nail20 extends into cavity 1 formed in the canal 2 of the femur 4 towarddistal condyle 76 of the femur 4. The nail 20, depending on its length,may extend into the condyle 76 or may end short of the condyle 76.

The distal portion 50 may, as shown in FIG. 2, include a first distalopening 78 and, for example, a second distal opening 80 spaced from, andmay as is shown in FIG. 2, be parallel to the first distal opening 78.The first distal opening 78 and the second distal opening 80 may, asshown in FIG. 2, be normal or perpendicular to centerline 56 of thedistal portion of the nail 20. First distal screw 82 may be slidablyfitted into the first distal opening 78 and a second distal screw 84 maybe slidably fitted into the second distal opening 80. The first distalscrew 82 and the second distal screw 84 may, as is shown in FIG. 2, bein the form of a cortical screw for engagement with external corticalwalls of the cortical bone 6 of the femur 4.

Since proximal hip condyle 86 of the femur 4 may be larger than theshanked portion of the femur 4, the proximal portion 48 of the nail 20may have a diameter DP, which is larger than the diameter DD of thedistal portion 50 of the nail 20. The nail 20 may, as is shown in FIG.1A, have a generally circular shape. It should be appreciated that thenail may also have other shapes. The nail 20 may be solid or may, asshown in FIGS. 1 and 2, be cannulated and be defined by the longitudinalopening or cannula 66. It should be appreciated that the nail 20 mayrather than the cannula include a longitudinal groove to substitute forthe cannula 66.

Referring now to FIG. 3, the nail 20 of the present invention is shownin the medial/lateral plane. In the medial/lateral plane, the nail 20has a shape to conform to the bow in the natural femur. For example andas is shown in FIG. 3, the nail 20 includes the proximal portion 48 andthe distal portion 50. The distal portion 50 includes an arcuate portion88 defined by radius R extending from origin 90. The distal portion 50also includes an end portion 92 extending from the arcuate portion 88.The end portion 92 is defined by angle θ θ. The end portion 92 includesthe first distal opening 78 and the second distal opening 80.

The nail 10 may, as shown in FIG. 3 include a relief surface such as aflat surface for example a chamfer 49 for assisting in leading thecurved nail 10 into the medullary canal of the long bone, for examplethe femur. It should be appreciated that the chamfer may have a surfacethat is not flat, for example arcuate, for example a portion of a sphereor a cylinder.

Referring now to FIG. 3A the chamfer 49 is shown in the medial/lateralview with chamfer 49 shown on the side of the distal tip opposed to theorigin 90 of the curved portion of the nail 10. The chamfer may bedefined by angle 82 from the longitudinal periphery of the nail 10. Thechamfer may be further defined by chamfer length CL from the distal endof the nail 10.

Referring now to FIG. 3B the chamfer 49 is shown in theanterior/posterior view with chamfer 49 shown at distal tip. It shouldbe appreciated that the tip may be larger or smaller than shown.

Referring now to FIG. 4, the proximal portion 48 of the nail 20 is shownin greater detail. The proximal portion 48 includes the first opening28, which defines first opening centerline 34. The proximal portion 48also includes second opening 32 defining second opening centerline 36.The proximal portion 48 also includes the third opening 68 definingthird opening centerline 70. The nail 20 further defines a counter bore94 extending from the proximal end of the proximal portion 48. As shownin FIG. 4, the counter bore 94 is generally concentric with thelongitudinal opening 66 of the nail. The counter bore 94 definesinternal threads 96 for cooperation with a fastener to lock the screws.

The nail 20 further includes a transverse slot 98 which may be helpfulfor guiding the nail 20 during installation.

Referring now to FIG. 5, second assembly 12 of a nail assembly inaccordance with the present invention is shown. The second nail assembly12 is for use in securing the greater trochanter 44 to the lessertrochanter 46. The second assembly 12 includes the nail 20 of FIGS. 1through 4 and the first screw 38. The first screw 38 is placed in firstopening 28 and the head 42 of the first screw 38 is advanced until itseats against cortical bone 6 of the femur 4. The shank 40 of the screw38 extends into the cancellous bone 8, through the first opening 28 andthrough additional cancellous bone 8. The shank 40 also engages corticalbone 6 to secure the screw 38 to the femur 4.

Referring now to FIG. 6, yet another aspect of the present invention isshown as third nail assembly 14. The third nail assembly 14 is for useto engage the neck 3 and the head 5 of the femur or long bone 4. Thenail assembly 14, as shown in FIG. 6, includes the nail 20 as well assecond screw 58. The second screw 58 is slidably fitted in secondopening 32 of the nail 20. The second screw 58 is placed into the secondopening 32 with head 62 of the second screw 58 positioned againstcortical bone 6 and shank 60 of the second screw 58 extending throughthe cortical bone 6 into cancellous bone 8. The second screw 58 furtherextends through the opening 32 and into the cancellous bone 8. Thesecond screw 58 extends through the neck 3 and may extend into the head5 within the cancellous bone 8.

While the nail assembly 14 may be operable with a solitary screw, forexample, second screw 58, the third assembly 14 may also include anadditional screw in the form of third screw 67. The third screw 67 isutilized in the third assembly 14 to provide fixation of the neck 3 andthe head 5. The third screw 67 is slidably fitted into the third opening68 of the nail 20. The third screw 67 includes a head 69 and a shaft orshank 71. The head 69 of the screw 67 rests against the outer surface ofthe cortical bone 6 of the femur 4. The shank 71 extends throughcortical bone 6, cancellous bone 8, the third opening 67, and into thecancellous bone 8. The third screw 67 extends into the cancellous bone 8of the neck 3 and into the cancellous bone 8 of the head 5. As shown inFIG. 6, the third screw 67 when assembled into the third opening 68 mayextend along third centerline 70, which is parallel and spaced fromsecond opening centerline 36.

While the second screw 58 and the third screw 67 may be fully threaded,as is shown in FIG. 6, it should be appreciated that the second screw 58and the third screw 67 may be partially threaded.

For example, and referring now to FIG. 7, yet another form of thepresent invention is shown as fourth nail assembly 16. The fourth nailassembly 16 is in the form of a nail assembly with screws that are onlypartially threaded. The use of partially threaded may permit the slidingcompression or motion of the head and neck in a downward fashion tofacilitate healing.

The fourth nail assembly 16 of FIG. 7 includes the nail 20 of FIGS. 1through 5 as well as second partially threaded screw 58A similar to thescrew 58 of FIG. 6. The second screw 58A, as shown in FIG. 7, is,however, only partially threaded in shank 60A of the second screw 58A.

Similarly, the fourth nail assembly 16 includes a third screw 67Asimilar to the third screw 67 of FIG. 6. The third screw 67A has a shank71A that is, however, only partially threaded.

As shown in FIG. 7, the second screw 58A includes a head 62A, whichrests against cortical bone 6 of the femur 4. The shank 60A of thesecond screw 58A includes a smooth portion 73A of the shank 60A, whichis positioned between the head 62A and threads 64A of the screw 58A. Thesmooth portion 73A of the second screw 58A extends from the head 62A,through the cortical bone 6, through cancellous bone 8, through thesecond opening 32 of the nail 20, through cancellous bone and to thethreads 64A of the shank 60A.

Similarly, the third screw 67A includes a smooth portion 75A of theshank 71A, which extends from head 69A to threads 77A of the shank 71A.The third screw 67A when installed in the nail 20 is installed such thathead 69A of the third screw 67A rests against the outer wall of thecortical bone 6 of the femur 4. The smooth portion 75A of the shank 71Aextends through cortical bone 6, through cancellous bone 8, through thethird opening 68, and into the cancellous bone 8. The threads 77A extendfrom the smooth portion 75A of the shank 71A. It should be appreciatedthat the smooth portion 73A of the second screw 58A and the smoothportion 75A of the third screw 67A extend through the respective secondopening 32 and third opening 68 of the nail 20, such that slidingcompression of the fractured hip joint may be provided.

Referring now to FIG. 8, yet another form of the present invention isshown as fifth nail assembly 18. The fifth nail assembly 18, as shown inFIG. 8, includes both a fully threaded screw and a partially threadedscrew.

Referring now to FIG. 8, yet another form of the present invention isshown as fifth nail assembly 18. The fifth nail assembly 18 utilizesboth a partially thread and a fully threaded screw. The fifth assembly18 as shown in FIG. 8, includes the nail 20 as well as second screw 58Aand third screw 67. The second screw 58A is fitted into second opening32 and the third screw 67 is fitted into third opening 68.

The nail 20 may be made of any suitable durable material and may, forexample, be made of a plastic, a metal or a carbon fiber compositematerial. To obtain the strength necessary, the nail 20 is preferablymade of a metal. If made of a metal, the nail 20 may be made of a metalthat is compatible with the human anatomy and is sterilizable. Suchmaterials include cobalt chromium alloy, a stainless steel alloy, and atitanium alloy.

Referring now to FIG. 9, the first screw 38, as is shown in greaterdetail. The first screw 38 as shown in FIG. 9, is in the form of acortical screw for securing the screw to cortical bone. The first screw38 includes the head 42 and the shank 40. The shank 40 includes threads64 for engagement with bone. The screw 38 as shown in FIG. 9, mayinclude a self-tapping feature 79 for tapping or preparing the threadsin the bone to receive cortical threads 11 of the screw 38. It should beappreciated that the self-tapping feature 79 may also include aself-drilling feature similar to and provide the opening in the bone forpreparing the bone for receiving the threads 64.

Referring now to FIG. 9A, the first distal screw 82 is shown in greaterdetail. The first distal screw 82 includes a head 81 and a threadedshank 83. The shank 83 may be threaded with cortical screw threads forengagement with cortical bone. The shank 83 may also include aself-tapping feature similar to the self-tapping feature 79 of the screw38 of FIG. 9.

Referring now to FIG. 9B, the second distal screw 84 is shown in greaterdetail. The second distal screw 84 includes a head 85 as well as a shank87. Shank 87 may include cortical threads and may include a self-tappingfeature similar to the self-tapping feature 79 of the screw 38 of FIG.9.

The cortical screws 38, 82 and 84 may be made of any suitable durablematerial and may, for example, be made of a plastic, a metal or a carbonfiber composite material. To obtain the strength necessary, the screwsare preferably made of a metal. If made of a metal, the screws may bemade of a metal that is compatible with the human anatomy and issterilizable. Such materials include cobalt chromium alloy, a stainlesssteel alloy, and a titanium alloy.

Referring now to FIG. 10, cancellous screws for use with theintramedullary nail of the present invention are shown. For example asshown in FIG. 10, second screw 58 includes head 62 as well as shank 60extending from the head 62. The shank 60 includes threads 64 that may bepositioned on the entire shank 60 or, alternatively, be provided only ona portion of the shank 60. The second screw 58 may include aself-drilling and self-tapping feature 89 located on the end of thethreads 64 to provide for self-drilling and self-tapping of the thread64 through cancellous bone.

Now referring to FIG. 10A, the third screw 67 is shown. The third screw67 may likewise be a cancellous screw and include a head 69 as well as ashank 71. The shank 71 may include threads 77, which are positioned onthe entire shank 71 of the third screw 67. The third screw 67 mayfurther include a self-tapping and self-drilling feature 91 similar tothe self-tapping and self-drilling feature 89 of the second screw 58.The third screw 67 may alternately include a shank 71, which is notfully threaded. For example and as shown in FIG. 10 in phantom,unthreaded shank portion 75A may be included in alternate screw 67A.

According to the present invention and referring now to FIG. 11, yetanother embodiment of the present invention is shown as intramedullarynail assembly 110. The intramedullary nail assembly 110 as shown in FIG.11, is for use with right femur 4. The intramedullary nail assembly 110of FIG. 11 is a mirror image of the nail assembly 10 of FIGS. 1 and 2.The intramedullary nail assembly 110 includes a nail 120 that is amirror image of the nail 20 of FIGS. 1 and 2.

The intramedullary nail 120 may have any suitable shape to fit withincanal 2 of femur 4. To fit within the canal 2, the nail 120 may belongitudinally elongated. For simplicity and to fit into the canal 2,the nail 120 may have a generally circular cross section. The nail 120may be linear or straight or may be curved and bent to more closelyconform to the shape of the canal 2. The nail 120 may be solid or, as isshown in FIG. 11, be cannulated or include a central opening 166extending along the length of the nail 120.

The nail 120 as shown in FIG. 11, may include a proximal portion 148 aswell as a distal portion 150 extending from the proximal portion 148.The proximal portion 148 defines a proximal portion centerline 154,while the distal portion 150 defines a distal portion centerline 156.The proximal portion centerline 154 forms an angle α′ with respect tothe distal portion centerline 156. Such an angular relationship betweenthe proximal portion 148 and the distal portion 150 facilitates the nail120 to be installed through greater trochanter 44 of the femur 4.

The assembly 110 may include screws, for example first screw 138, foruse with the nail 120. The screws may be used to connect greatertrochanter 44 with the lesser trochanter 46 or alternatively, or incombination, the nail assembly 110 may also include screws (describedlater) for engagement with neck 3 and head 5 of the femur 4. The nail120, as is shown in FIG. 11, may, thus, include a first opening 128defining a first opening centerline 134. The first opening 128 isadapted for receiving a screw for connecting the greater trochanter 44to the lesser trochanter 46.

The nail 120 may further include a second opening 132 defining a secondopening centerline 136. The second opening 132 may be adapted forreceiving a screw for engagement with neck 3 and head 5 of the femur 4.The nail 120 may further include a third opening 168 defining a thirdopening centerline 170. The third opening 168 may be adapted forreceiving a third screw. The third opening 168, as shown in FIG. 11, maybe parallel to the second opening 132. The screw for the third opening168 may be positioned in the neck 3, as well as, in the head 5 of thefemur 4.

The nail assembly 110 may further include distal screws for distallysecuring the nail 120 to the femur 4. For example and as shown in FIG.11, the nail 120 may include a first distal opening 178 for receiving afirst distal screw 182. The first distal screw 182, as shown in FIG. 11,may be normal or perpendicular to distal portion centerline 156. Thenail 120 may further include a second distal opening 180 spaced from andparallel to the first distal opening 178. The nail assembly 110 mayfurther include a second distal screw 184 for cooperation in the seconddistal opening 180 of the nail 120. The first distal screw 182 and thesecond distal screw 184 may be in the form of cortical screws that maycooperate with cortical bone 6 of the femur 4.

Referring now to FIG. 12, the medial/lateral view of the nail 120 isshown. The proximal portion 148 of the nail 120 includes the firstopening 128, the second opening 132 and the third opening 168. Theproximal portion 148 may be, as is shown in FIG. 12, larger in diameterthan the distal portion 150, so that the screw openings may beaccommodated in the proximal portion 148.

The distal portion 150 as shown in FIG. 12, may have a shape conformingto a right femur. For example and as is shown in FIG. 12, the distalportion 120 may be arcuate and may be defined by a radius R′ extendingfrom origin 190. The arcuate shape of the distal portion 150 correspondsto the arcuate shape of the right femur medullary canal, in which thenail 120 is positioned.

As shown in FIG. 12, the distal portion 150 of the nail 120 may includea distal portion which may not be arcuate, but may extend at an angle 8′from the distal portion 150. The distal part of the distal portion 150may include the distal openings. For example, the distal portion 150 mayinclude a first distal opening 178, which may, as is shown in FIG. 12,be generally cylindrical in shape as well as a second distal opening180.

Referring now to FIG. 12A, the second distal opening 180 may begenerally oval. For example and as shown in FIG. 12, the second distalopening 180 may be defined by a overall length L′ and a width W′. Thesecond distal opening 120 may further be defined by radii R″, located onboth ends of the second distal opening 180.

Referring now to FIG. 13, the proximal portion 148 of the nail 120 isshown in greater detail. The nail 120 may include the longitudinalopening 166, as well as first opening 128 defining first openingcenterline 134. The proximal portion 148 may further define the secondopening 132 defining the second opening centerline 136. The proximalportion 148 may further define the third opening 168 defining thirdopening centerline 170.

To lock at least one of the screws with respect to the nail 120, thenail 120 may include a feature for locking the screw to the nail. Forexample, the nail 120 may include a counter bore 194 onto which internalthreads 196 are formed. The internal threads 196 may be adapted forfitting to a fastener used to contact the screw to lock the screw to thenail 120. The nail 120 may further include a slot 198 to angularlyposition the nail 120.

Referring now to FIG. 14, another embodiment of the present invention isshown as intramedullary nail assembly 112. The intramedullary nailassembly 112 includes the nail 120 of FIGS. 11 through 13. The nailassembly 112 of FIG. 14 is adapted for connection of the greatertrochanter 44 with the lesser trochanter 46. The nail assembly 112includes first screw 138 for positioning in the first opening 128. Thefirst screw 138 may as shown be a cortical screw and is similar to thescrew 38 of the nail assembly 10 of FIGS. 1-9. The first opening 128 ispositioned such that the first opening centerline 134 extends fromgreater trochanter 44 to lesser trochanter 46.

Referring now to FIG. 15, yet another embodiment of the presentinvention is shown as intramedullary nail assembly 114. Theintramedullary nail assembly 114 is used to connect the lesser andgreater trochanter 144 and 146, respectively, as well as to secure thefemoral neck 3 to the femur 4.

The nail assembly 114 as shown in FIG. 15, is adapted for use with aright femur. The nail assembly 114 includes the nail 120. First screw138, as well as, second screw 158. The second screw 158 is similar tosecond screw 58 of the nail assembly 10 of FIGS. 1-9. The second screw158 is adapted for engagement with the femoral neck 3 and is preferablyin the form of a cancellous screw.

The first screw 138 is fitted into the first opening 128, while thesecond screw 158 is fitted into the second opening 132. The first screw138 extends from the greater trochanter 44 to the lesser trochanter 46.The second screw 158 extends from the outer cortical wall of the longbone or femur 4 through the second opening 132 and into cancellous bonewithin the neck 3 and head 5 of the femur 4.

As shown in FIG. 15, the first screw 138 and the second screw 158, wheninstalled in the nail 120, form an (X) shape with the nail 120. Thefirst screw 138 and second screw 158 may both be installedsimultaneously because the first screw opening 128 and the second screwopening 132 are not coplanar, but they are oblique with respect to eachother. Therefore, the first opening 128 and the second opening 132 donot intersect with each other. Therefore, the first screw 138 and thesecond screw 158, when both are installed into the nail 120, do notintersect with each other and therefore may both be utilizedsimultaneously.

Referring now to FIG. 16, yet another embodiment of the presentinvention is shown as nail assembly 116. The nail assembly 116 includesthe nail 120 as well as second screw 158 and third screw 167. The thirdscrew 167 may be similar or even identical to the second screw 158.

The second screw 158 extends through second opening 132 and extends fromthe outer cortical wall of the femur 4 through the second opening 132and into the cancellous bone of the neck 3 and head 5. Similarly, thethird screw 167 is fitted in the third opening 168. The third screw 167may, for simplicity, be in a position spaced from and parallel to thesecond screw 158. The third screw 167 extends from the outer corticalwall of the femur 4, through the third opening 168 and into thecancellous bone in the neck 3 and head 5 of the femur 4.

As shown in FIG. 16, the second screw 158 and the third screw 167 may,as is shown in FIG. 16, include a smooth portion for assisting inproviding for sliding compression of the femoral neck fracture. Forexample and as shown in FIG. 16, the second screw 158 includes a smoothportion 157 for positioning through the second opening 132. The smoothportion 157 assists in the sliding compression of the fracture. Thesecond screw 158 further includes a threaded portion 159 havingcancellous threads 161, which are located in the neck 3 and head 5 ofthe femur 4. The third screw 167 is similar to the second screw 158 andincludes a smooth shank portion 169 slidably fitted in the third opening168. The third screw 167 further includes a threaded portion 171extending outwardly from the threaded portion 169. The threaded portion171 includes cancellous threads 173 for cooperation with the cancellousbone in the neck 3 and head 5.

Referring now to FIG. 17, yet another embodiment of the presentinvention is shown as nail assembly 210. The nail assembly 210 issimilar to the nail assembly 16 of FIG. 7, except that the nail assembly210 of FIG. 17 uses screws, which have a different thread form tominimize medial migration of the thread through the head 5 and femoralneck 3. For example and as shown in FIG. 17, the nail assembly 210includes nail 220 which is similar to the nail 20 of FIG. 7, except thatthe openings in the nail 220 may be larger to accommodate largerdiameter screws. The nail 220 includes a proximal portion 248 as well asa distal portion 250 extending from the proximal portion 248. The nail220 may be solid or may, as is shown in FIG. 17, be hollow or include acentral opening or cannula 266 extending longitudinally through thecentral portion of the nail 220.

The proximal portion 248 defines a proximal portion centerline 254 andthe distal portion 250 defines a distal portion centerline 256. Theproximal portion centerline 254 and the distal portion centerline 256define an angle α″ therebetween. The angle α″ is established to assistthe installation of the nail 220 through greater trochanter 44.

The nail 220 is adapted for use with femoral neck fractures as well asgreater trochanter to lesser trochanter fractures. Therefore, and asshown in FIG. 17, the nail 220 includes a first opening 228 extending inthe direction of first opening centerline 234. The first openingcenterline 234 extends from greater trochanter 44 to lesser trochanter46. The nail 220 further includes a second opening 232, which definessecond opening centerline 236. The second opening centerline 236 isoriented in a direction toward the neck 3 and head 5 of the femur 4. Thesecond opening 232 may be larger than the opening 32 of the nail 20 toaccommodate a larger fastener.

The nail 220 further includes a third opening 268 positioned in adirection along third opening centerline 270. As shown in FIG. 17, thethird opening centerline 270 is parallel and spaced from the secondopening centerline 236. The third opening 268 may be smaller in sizethan the second opening 232 to receive a smaller screw. The thirdopening 268 may be provided to provide for a smaller screw that mayserve as anti-rotation screw for the nail assembly 210.

The nail assembly 210 includes a second screw 258 that is slidablyfitted in the second opening 232 of the nail 220. The second screw 258is different than the second screw 58 of the nail assembly 10. Thesecond screw 258 is adapted to limit the medial migration of the screw258. The second screw 258 includes a head 262 and a shank 260 extendingfrom the head 262. The shank 260 may include external cancellous screwthreads 264 for engaging with the cancellous bone 8 located in the neck3 and head 5 of femur 4.

The nail assembly 210 may further include a third screw 267. The thirdscrew 267 extends along centerline 270 of the third opening 268 and isslidably positioned within the third opening 268 of the nail 220. Thethird screw 267 may, as is shown in FIG. 17, be parallel and spaced fromthe second screw 258. The third screw 267 may be smaller in diameterthan the second screw 258. Since the third screw 267 may be utilized asan anti-rotation device, the third screw 267 may be substantiallysmaller than the second screw 258. The third screw 267 may include ahead 269 and a shank 271. The shank 271 may include threads 277 forengaging cancellous bone 8 formed in the neck 3 and head 5 of femur 4.

The length of the second screw 258 and the third screw 267 aredetermined so that the screw head rests against the cortical wall 6 ofthe femur 4 and the screw shank extends into the head 5 of the femur 4.

Referring now to FIG. 17A, the first opening 228, the second opening232, and the third opening 268 of the nail 220 are shown in greaterdetail. First opening centerline 234 intersects centerline 254 of theproximal portion 248 of the nail 220. The first opening centerline 234and proximal portion centerline 256 defines first plane 272. The secondopening centerline 236 also intersects centerline 254 of the proximalportion 248. The third opening centerline 270 also intersects centerline254 of the proximal portion 248 of the nail 220. In fact, the secondopening centerline 236 and the third opening centerline 270 form secondplane 274. The first plane 272 and the second plane 274, as shown inFIG. 17A, form angle σ′ therebetween.

Referring now to FIG. 18, the nail assembly 210 is shown in theanterior/posterior view. The nail assembly 210 includes the proximalportion 248, as well as, the distal portion 250. The proximal portion248 includes first opening 228, second opening 232, and third opening268.

The distal portion 250 of the nail 220 of the nail assembly 210 includesa first distal opening 278 which may, as shown in FIG. 18, besubstantially perpendicular or transverse to longitudinal axis 256 ofthe nail 220. The distal portion 250 of the nail 220 may further includea second distal opening 280 spaced from and parallel to the first distalopening 278. The first distal opening 278 and the second distal opening280 may be utilized in cooperation with fasteners to provide for distalfixation of the nail 220.

For example, and as is shown in FIG. 18, the nail assembly 210 furtherincludes a first distal screw 282 that is fitted through the firstdistal opening 278 of the nail 220. The nail assembly 210 may furtherinclude a second distal screw 284 that is fitted through the seconddistal opening 280. The first distal screw 282 and the second distalscrew 284 may be in the form of cortical screws and may engage with theexternal cortical walls 6 of the femur 4.

Referring now to FIG. 19, a medial/lateral view of the nail 220 of thenail assembly 210 is shown. The nail 220 includes the proximal portion248, as well as, the distal portion 250. The distal portion 250 may, asis shown in FIG. 19, have a shape generally conforming to that of thecanal of the long bone. For example, and as is shown in FIG. 19, thedistal portion 250 may include an arcuate portion 288 and an end portion292 extending from the arcuate portion 288. The arcuate portion 288 maybe defined by a radius R2′ extending from origin 290. The end portion292 of the distal portion 250 may extend from the arcuate portion 288and may be generally linear.

Referring now to FIGS. 20 and 21, the screw 258 may further include aremoval feature 231 in the form of, for example, internal threads formedin the small counter bore 233 formed in the longitudinal opening 266adjacent second end 235 of the screws 258. The screw 258 may furtherinclude a large counter bore 237 extending from the second end 235 ofthe lag screw 258 and concentric with the small counter bore 233 as wellas with the longitudinal opening 266.

Referring now to FIG. 21, the screw 258 may further include a pluralityof threads 264 formed on the shank periphery 241 of shank 260 of thescrew 258. The threads 264 may as shown in FIG. 21 have a non-uniformcross-section, which is more fully described in U.S. patent Ser. No.11/168,737 incorporated hereby in its entirety.

Referring again to FIG. 21, the periphery 241 of the shank 260 of thescrew 258 includes a first portion 243 into which the threads 264 areformed. It should be appreciated that the first portion 243 may extendalong longitudinal axis 245 of the screw 258 from first end 247 tosecond end 325 of the screw 258. It should also be appreciated and as isshown in FIG. 21, that the periphery 241 may include a second portion249. The second portion 249 of periphery 241 of the shank 260 may definea smooth surface 251. As is shown in FIG. 21, the periphery 241 of theshank 260 may be generally cylindrical and defined by a diameter, forexample, DS.

The screw 258 as is shown in FIG. 21, is generally cylindrical anddefined by the diameter DS and an overall length L. The shank 260 of thescrew includes the first portion 243 which include threads 264 and thesecond portion 249 having the smooth surface 251. The overall length L,of the diameter DS is divided into a thread TL and a smooth orunthreaded length UL. The thread length TL defines the first portion 243and the smooth length UL defines the second portion 249. The threadlength TL may, for example, be a portion of, for example, 20-40% of theoverall length L of the shank 260. It should be appreciated that thesmooth length UL is preferably a sufficient length such that the secondportion 249 of the screw 258 may be positioned in the oblique thirdopening 268 of the intramedullary nail 220 (see FIG. 17) to permitcompression of the bone fracture of femur 4.

The threads 264 as is shown in FIG. 21, may advance spirally around theperiphery 241 of the shank 260 of the screw 258. The threads 264 may bedefined by a pitch P defining a spacing along longitudinal axis 245between adjacent threads. The threads 264 may advance spirally aroundthe longitudinal axis 245 in either a right or a left hand spiralconfiguration. The threads may, as is shown in FIG. 21, be of a singlelead type but may alternatively be double lead configuration or a triplelead configuration.

Referring now to FIG. 23, the threads 264 may have any suitable shape orthread form. For example and as shown in FIG. 23, the threads 264 mayhave a combination box and tapered configuration. For example and isshown in FIG. 23, the threads 264 may have any suitable shape or profile253. For example and is shown in FIG. 23 the profile 253 may include acrest 255 and opposed root 257. A trailing surface 261 is positionedbetween the crest 255 and the root 257 adjacent the second end 235 ofthe screw 258 while leading edge 263 is positioned between the crest 255and root 257 adjacent the first end 247 of the screw 258.

As shown in FIG. 23, the leading edge 263 and the trailing edge 261 maybe configured to provide for less force to assemble in the direction ofarrow 261 than to disassemble in the direction opposed to arrow 261.Such ease of assembly and difficulty in disassembly may be accomplishedas is shown in FIG. 23 by providing the trailing edge 261 with aconfiguration that is normal or perpendicular to the root 257 and thecrest 255 while providing the leading edge 263 with chamfered or angledsurface or, as is shown in FIG. 23, or with a partially angled surfacebetween the crest 255 and the root 257.

Referring to FIG. 23, the threads 267 are shown in greater detail. Thethreads 264 of the screw 258 may, as is shown in FIG. 23, include theleading edge 263 such that the leading edge 263 includes normal orperpendicular portion 265 as well as an angled portion 267. The angledportion 267 provides for reduced force to assemble the screw 258 intothe long bone or femur 4. The normal portion 265 and the angled portion267 may define an angle αα therebetween. To minimize stress, the crest255, the root 257, trailing edge 261, and leading edge 263 may includearcuate portions therebetween to minimize the stress.

Referring now to FIG. 22-22E, alternative profile configuration forthreads of the screw of the nail of the present invention is shown.According to the present invention and referring now to FIG. 22, anotherform of profile of the screw of the present invention. The screw 258F ofFIG. 22 includes threads 264F defining profile 253F. The profile 253Fincludes a spaced apart parallel crest 255F and root 257F. The profile253F includes a trailing surface 261F, which is normal to the root 257Fand the crest 255F. The profile 253F further includes a leading surface263F, which is positioned at angle between root 257F and crest 255F.

Referring now to FIG. 22A, profile 253A is shown which includes arcuateroots and crest. For example and is shown in FIG. 22A, the profile 253Aof screw 258A includes an arcuate crest 255A to which trailing angledsurface 261A extends. Leading edge 263A extends likewise from thearcuate crest 255A. The profile 253A further includes an arcuate root257A, which connects with trailing surface 261A and leading surface263A.

Referring now to FIG. 22B, yet another profile for threads for screw ofthe present invention is shown as screw 258B includes threads 264Bhaving a profile 253B which include generally v-shaped threads 264B. Theprofile 253B includes trailing surface 261B and leading surface 263B.Root 257B and crest 255A are as shown in FIG. 22B are minimal.

Referring now to FIG. 22C, yet another profile of threads for a screwaccording to the present invention is shown. For example and is shown inFIG. 22C, the screw 258C includes threads 264C having a profile 253Cthat is blocked or rectangular. The profile 253C includes parallel andspaced apart root 257C and crest 255C. The profile 253C includes atrailing surface 261C, a spaced apart and parallel leading surface 263C.The trailing surface 261C and the leading surface 263C are normal orperpendicular to the root 257C and the crest 255C.

Referring now to FIG. 22D, yet another embodiment of a profile ofthreads for a screw according to the present invention is shown. Theprofile 253D of threads 264D of the screw 258D has a generally truncatedv-shape of that of a standard screw thread. The profile 253D includes aflat crest 255D and opposed angled trailing surfaces 261D and leadingsurface 263D. A root 257D extends from the trailing surface 261D and theleading surface 263D.

Yet another profile of threads of a screw of the present invention isshown as profile 253E. Screw 258E includes threads 264E having theprofile 253E. The profile 253E includes a leading surface 263E that isnormal to a crest 255E and a spaced apart parallel root 257E. Theprofile 253E further includes a trailing surface 261E that is positionedat an angle between the root 257E and the crest 255E.

Referring now to FIGS. 24 and 25, yet another embodiment of the presentinvention is shown as nail assembly 310. The nail assembly 310 issimilar to the nail assembly 14 of FIG. 6, except that the nail assembly310 is for use with a right femur rather than a left femur. For exampleand as shown in FIG. 24, the nail assembly 310 includes a nail 320 thatis the mirror image of the nail 20 of FIG. 6. The nail 320 includes aproximal portion 348 as well as a distal portion 350. The proximalportion 348 includes a first opening 328 for use in connecting thegreater trochanter 44 to the lesser trochanter 46. The proximal portion348 also includes a second opening 332 and a third opening 368 forengagement with the neck 3 and head 5 of femur 4.

The distal portion 350 of the nail 320 includes a first distal opening378. The first distal opening 378 may be generally perpendicular ornormal to longitudinal axis 356 of the distal portion 350 of the nail320. The distal portion 350 of the nail 320 may further include a seconddistal opening 380 spaced from and generally parallel to the firstdistal opening 378. The first distal opening is sized to receive firstdistal screw 382. Similarly, the second distal opening 380 is sized toreceive second distal screw 384. The first distal screw 382 as well asthe second distal screw 384 may, as shown in FIG. 24, be in the form ofcortical screws, which engage with cortices 6 of the femur 4.

The nail assembly 310 as shown in FIG. 24, is for use in securingfemoral neck fractures and as such, includes a second screw 358, whichis slidably fitted in second opening 332. The second screw 358, as isshown in FIG. 24, is a fully threaded screw and extends into the neck 3and head 5 of femur 4. The second screw 358 may be in the form of acancellous screw. The nail assembly 310 further includes a third screw367, which is slidably fitted in the third opening 368. The third screw367 extends from cortical wall 8 of the femur 4 through the thirdopening 368 and into the neck 3 and head 5 of femur 4. The third screw367 is positioned parallel and spaced from the second screw 358. Thethird screw 367 may be in the form of a fully threaded cancellous screw.

Referring now to FIG. 25, the medial/lateral view of the nail 320 isshown. The nail 320 includes the proximal portion 348 as well as thedistal portion 350. The proximal portion 348 may be generally linear.The distal portion 350 may include an arcuate portion 388 as well as anend portion 392. The arcuate portion 388 and the end portion 392 aredesigned to conform with the canal of a right femur. The arcuate portion388 may be described, for example, by radius R2″ extending from origin390. The end portion 392 may extend at, for example, angle θ′″. The endportion 392 may include first distal opening 378, which, as is shown inFIG. 25, may have a generally circular shape. The end portion 392 mayfurther include the second distal opening 380, which may, as shown inFIG. 25, have a generally oval shape.

Referring now to FIG. 26, yet another embodiment of the presentinvention is shown as nail assembly 312. The nail assembly 312 utilizesthe nail 320 of FIGS. 24 and 25, but utilizes screws in a differentfashion. The nail assembly 312 provides for screws with a generally (X)shape and may be used to repair fractures that include both a greatertrochanter to lesser trochanter fracture, as well as a femoral neckfracture. The nail assembly 312 includes the nail 320, as well as, afirst screw 338 and second screw 358. The first screw 338 is slidablyfitted in the first opening 328 and extends from greater trochanter 44to lesser trochanter 46. The second screw 358 extends through secondopening 332 and engages neck 3 and head 5 of femur 4.

Referring now to FIG. 27, yet another embodiment of the presentinvention is shown as nail assembly 410. The nail assembly 410 as shownin FIG. 27, is for use in a left femur and includes the nail 410, whichis suitable for entry into the piriforma fossa 9 of the femur 4. In thatthe nail 410 is inserted through piriforma fossa 9 of the femur 4, thenail in the anterior/posterior view as shown in FIG. 27, is generallystraight. The nail 410 as shown in FIG. 27, includes a proximal portion448 and a distal portion 450. The nail 410 may include a central openingor cannula 466 and have a longitudinal centerline 454 that is generallystraight or linear in the anterior/posterior view of FIG. 27.

The nail assembly 410 further includes a second screw 458, which isslidably fitted in second opening 432 of the nail 420. The second screw458, as shown in FIG. 27, is in the form of a partially threaded screwand includes a head 462 and a shank 460, including a portion havingthreads 464. The second screw 458 extends into the cancellous bone 8 ofthe neck 3 and head 5 of the femur 4.

The nail assembly 410 of FIG. 27 may further include a third screw 467slidably fitted into third opening 468 formed in the nail 420. Thesecond opening 432 defines a second opening centerline 436. The thirdopening 468 defines a third opening centerline 470. The second openingcenterline 436 and the third opening centerline 470, as shown in FIG.27, may be parallel and spaced apart. The nail assembly 420 may furtherinclude a third screw as shown in phantom as first screw 438. The firstscrew 438 may be fitted into first opening 428 formed in the nail 420.

The third screw 467 may include a head 469 that rests against corticalbone 6 of the femur 4. The third screw 467 may include a shank 475including a smooth part as well as including external threads 477. Theexternal threads 477 of the third screw 467 may be of a cancellous typefor fitting and engaging with cancellous bone.

Referring now to FIG. 27A, the openings of the nail 410 are shown ingreater detail. The nail 410 includes the first opening 428 extendingalong first opening centerline 434. The first opening centerline 434intersects with longitudinal axis 454 of the nail 420. The longitudinalaxis 454 of the nail 420 and the first opening centerline 434 define afirst plane 472.

The nail 410 further includes the second opening 432 defining secondopening centerline 436. The nail 420 further includes the third opening468, which defines the third opening centerline 470. As shown in FIG.27A, the second opening centerline 436 and the third opening centerline470 intersect the centerline 454 of the nail 420. The second openingcenterline 436, the third opening centerline 470 and the centerline 454of the nail 420 define second plane 474. The second plane 474 and thefirst plane 472 define an angle σ′″ therebetween.

Referring now to FIG. 28, yet another embodiment of the presentinvention is shown as nail assembly 412. The nail assembly 412 issimilar to the nail assembly 410 of FIG. 27, but utilizes fully threadedscrews rather than partially threaded screws. The nail assembly 412includes the nail 420 of FIG. 27. The nail 420 includes first opening428, second opening 432, and third opening 468. The nail 420 includesthe proximal portion 448 and the distal portion 450. The nail assembly412 includes a fully threaded second screw 458A that is slidably fittedin the second opening 432. The nail assembly 412 further includes afully threaded third screw 467A that is slidably fitted in the thirdopening 468.

The distal portion 450 of the nail 420 includes a first distal opening478, which is positioned transversely or perpendicular to thelongitudinal axis 454 of the nail 420. The nail 420 may further includea second distal opening 480 spaced from and generally parallel to thefirst distal opening 478. The nail assembly 412 may further includefirst distal screw 482, which may be fitted into the first distalopening 478. The nail assembly 412 may also include second distal screw484 for fitting to the second distal opening 480.

Referring now to FIG. 29, the medial/lateral view of the nail 420 foruse with the nail assembly 410 of FIG. 27, as well as with the nailassembly 412 of FIG. 28 is shown. The nail assembly 420 includes theproximal portion 448 as well as the distal portion 450. The proximalportion 448 includes the first opening 428, the second opening 432 andthe third opening 468. The distal portion 450 includes an arcuateportion 488 and an end portion 492. The arcuate portion 488 and the endportion 492 are configured to form into the arcuate intramedullary canalof the left long bone or femur.

The arcuate portion 488 is defined by radius R2′″ extending from origin490. The end portion 492 is generally linear and extends at an angle θ″″from the arcuate portion 488. The end portion 492 includes the firstdistal opening 478 and the second distal opening 480. The first distalopening 478 may, as is shown in FIG. 19, be generally cylindrical. Thesecond distal opening 480, as shown in FIG. 19, may be oval.

The nail 410 may, as shown in FIG. 29, include a relief surface such asa flat surface for example a chamfer 449 for assisting in leading thecurved nail 410 into the medullary canal of the long bone, for examplethe femur. It should be appreciated that the chamfer may have a surfacethat is not flat, for example arcuate, for example a portion of a sphereor a cylinder.

Referring now to FIG. 29A the chamfer 449 is shown in the medial/lateralview with chamfer 449 shown on the side of the distal tip opposed to theorigin 490 of the curved portion of the nail 410. The chamfer may bedefined by angle θ3 from the longitudinal periphery of the nail 410. Thechamfer may be further defined by chamfer length CL2 from the distal endof the nail 410.

Referring now to FIG. 29B the chamfer 449 is shown in theanterior/posterior view with chamfer 449 shown at distal tip. It shouldbe appreciated that the tip may be larger or smaller than shown.

Referring now to FIGS. 30, 31 and 32, the intramedullary nail ofassembly of the present invention, may be in the form of a piriformafossa nail for a right femur.

For example and as shown in FIG. 30, yet another embodiment of thepresent invention is shown as nail assembly 510. The nail assembly 510includes an intramedullary nail 520. The nail 520 includes a proximalportion 548 and a distal portion 550. The proximal portion 548 and thedistal portion 550 may be linear in the anterior/posterior view of FIG.30. In other words, the proximal portion 548 and the distal portion 550may be defined by a common longitudinal centerline 554. The proximalportion 548 includes a first opening 528, a second opening 532 and athird opening 568.

The distal portion 550 of the nail 520 may include a first distalopening 578, which is transverse or perpendicular to the longitudinalaxis 554 of the nail 520. The distal portion 550 of the nail 520 mayfurther include a second distal opening 580 spaced from and parallel tothe first distal opening 578.

The nail assembly 520 may include the nail 520, as well as, a secondscrew 558, which is slidably fitted into second opening 532. The secondscrew 558 may be a cancellous screw and may, as shown in FIG. 30, befully threaded. The second screw 558 may extend into the neck 3 and head5 of the femur 4. The nail assembly 510 may further include a thirdscrew 567, which is slidably fitted into third opening 568. The thirdscrew 567 may be in the form of a cancellous screw and may be parallelto and spaced from the second screw 558. The third screw 567 may extendinto the neck 3 and head 5 of the femur 4. The third screw 567 may beused as an anti-rotation device to avoid the rotation of the head 5 withrespect to the remainder of the femur 4.

The nail assembly 510 may further include a first distal screw 582 forslidably engagement with the first distal opening 578. The first distalscrew 582 may be in the form of a cortical screw and may extend fromfirst cortex 6 to the opposed cortex of the femur 4. The nail assembly510 may further include a second distal screw 582 for slidably fittinginto the second distal opening 580 of the nail 520. The second distalscrew 584 may be similar to the first distal screw 582 and may be in theform of a cortical screw.

Referring now to FIG. 31, the nail 520 for use with the nail assembly510 of FIG. 30 is shown in greater detail in a medial/lateral view. Thenail 520 preferably has a shape conforming to that of the medullarycanal of the right femur into which the nail 520 is to be inserted. Thenail 520 may include the proximal portion 548 and the distal portion550. The proximal portion 548 may include the first opening 528, thesecond opening 532 and the third opening 568.

The distal portion 550 may include an arcuate portion 588 having agenerally bowed shape to conform with the medullary canal of the femur.The arcuate portion 588 may be defined by radius R2′″″ extending fromorigin 590. The distal portion 550 may further include an end portion592, which is generally linear. The end portion 592 may extend at anangle θ′″″ from arcuate portion 588 and include the first distal opening578 and the second distal opening 580. The first distal opening 578, asis shown in FIG. 25, may be generally cylindrical. The second distalopening 580 may, as shown in FIG. 25, have an oval shape.

Referring now to FIG. 32, yet another embodiment of the presentinvention is shown as nail assembly 512. The nail assembly 512 utilizesthe nail 520 of FIGS. 30 and 31 and is used to repair neck fractures andgreater trochanter 44 and lesser trochanter 46 fractures, or to be ableto repair a fracture with both neck screw support and greater trochanterto lesser trochanter screw support. The nail assembly 520 includes thenail 520 as well as a first screw 538 and the second screw 558. Thefirst screw 538 is fitted into first opening 528 of the nail 520 andextends from greater trochanter 44 to lesser trochanter 46. The firstscrew 538 may be in the form of a cortical screw and be able to engagethe cortical wall 6 on both the greater trochanter and the lessertrochanter 546. The second screw 558 is fitted into second opening 532and extends from cortical wall 6 of the femur 4 into neck 3 and head 5of the femur 4. The second screw 558 may be in the form of a cancellousscrew to engage with cancellous bone 8 located in the neck 3 and head 5.

Referring now to FIG. 33, yet another embodiment of the presentinvention is shown as nail assembly or kit 600. The kit 600 includesnail 20. The kit 600 may also include a screw, for example, first screw38. The kit 600 may further include a second proximal screw in the formof, for example, partially threaded second proximal screw 658. The kit600 may further include third partially threaded screw 667. It should beappreciated that the kit 600 may include additional screws. For example,the kit 600 may include fully threaded screws for use in the femoralneck. The kit 600 may further include a second fully threaded screw 658Aas well as a third fully threaded screw 667A. It should be appreciatedthat the kit 600 may further include distal screws, for example, firstdistal screw 682 and second distal screw 684.

Referring now to FIG. 34, yet another embodiment of the presentinvention is shown as surgical technique or procedure 700. The surgicalprocedure 700 includes a first step 702 of providing an intramedullarynail. The nail includes a longitudinal axis and an external periphery.The external periphery is sized for fitting in the medullary canal ofthe long bone. The nail has a first internal wall defining a firstopening. The first opening defines a first opening centerline. The nailhas a second internal wall, which defines a second opening through thenail. The second opening defines a second opening centerline. The firstopening centerline and the second opening centerline are oblique withrespect to each other. The first opening centerline and the longitudinalaxis of the body form an acute angle between them. The method 700further includes a second step 704 of positioning the nail at leastpartially in the medullary canal. The method 700 further includes athird step 706 of providing a first screw for cooperation with the longbone and for slidable cooperation with the first opening and the nail.The method 700 further includes a fourth step 708 of inserting the firstscrew through the cortical wall of the lesser trochanter of the longbone. The method 700 further includes a fifth step 710 of inserting thefirst screw through the first opening, as well as a sixth step 712 ofinserting the first screw through the cortical wall of the greatertrochanter of the long bone. The method 700 further includes a seventhstep 714 of providing a second screw for cooperation with the long boneand for slidable cooperation with the second opening in the nail. Themethod 700 further includes an eighth step 716 of inserting the secondscrew through the cortical wall of the long bone and a ninth step 718 ofinserting the second screw through the second opening. The method 700further includes a tenth step 720 of inserting the second screw throughthe cortical wall of the long bone.

Referring now to FIG. 35, yet another embodiment of the presentinvention is shown as surgical procedure or surgical method 800. Themethod 800 includes a first step 802 of providing an intramedullarynail. The nail defines a longitudinal axis and an external periphery ofthe nail for fitting in the medullary canal of the long bone. The nailhas a first internal wall, which defines a first opening through thenail. The first opening defines a first opening centerline. The nail hasa second internal wall, which defines a second opening through the nail.The second opening defines a second opening centerline. The firstopening centerline and the second opening centerline are oblique withrespect to each other. The first opening centerline and/or the secondopening centerline are transverse to the longitudinal axis of the nail.The longitudinal axis of the body and the first opening centerline forman acute angle between each other. The longitudinal axis of the body andthe second opening centerline form an acute angel between each other.The method 800 includes a second step 804 of positioning the nail atleast partially in the medullary canal. The method 800 includes a thirdstep 806 of providing a first screw for cooperation with the long boneand for slidable cooperation with the first opening in the nail. Themethod 800 includes a fourth step 808 of inserting the first nailthrough the cortical wall of the lesser trochanter of the long bone. Themethod 800 includes a fifth step 810 of inserting the first screwthrough the first opening and a sixth step 812 of inserting the firstscrew through the cortical wall of the greater trochanter of the longbone. The method 800 further includes a seventh step 814 of providing asecond screw for cooperation with the long bone and for slidablecooperation with the second opening in the nail. The method 800 includesan eighth step 816 of inserting the second screw through the corticalwall of the long bone and a ninth step 818 of inserting the second screwthrough the second opening. The method 800 includes a tenth step 820 ofinserting the second screw through the cortical wall of the long bone.

Although the present invention and its advantages have been described indetail, it should be understood that various changes, substitutions, andalterations can be made therein without departing from the spirit andscope of the present invention as defined by the appended claims.

What is claimed is:
 1. An intramedullary nail for use in a medullarycanal of a long bone, said nail comprising: a body defining alongitudinal axis and an external periphery thereof for fitting in themedullary canal of the long bone, said body having a first internal wallthereof defining a first opening therethrough, the first openingdefining a first opening centerline, said body having a second internalwall thereof defining a second opening therethrough, the second openingdefining a second opening centerline, the first opening centerline andthe second opening centerline being oblique with respect to each other,the longitudinal axis of said body and the first opening centerlineforming an acute angle therebetween and the longitudinal axis of saidbody and the second opening centerline forming an acute angletherebetween.
 2. The nail as in claim 1, wherein at least a portion ofsaid body is cannulated along the longitudinal axis.
 3. The nail as inclaim 1, wherein at least a portion of said body defines a groove alongthe longitudinal axis.
 4. The nail as in claim 1, wherein at least oneof the first opening and the second opening have a generally cylindricalshape.
 5. The nail as in claim 1, wherein at least one of the firstopening and the second opening have a generally oval shape.
 6. The nailas in claim 1, wherein at least one of the first opening centerline andthe second opening centerline intersects the longitudinal axis of saidbody.
 7. The nail as in claim 1, wherein said body further comprises ainternal wall defining a third opening the first opening and the secondopening have a generally cylindrical shape.
 8. The nail as in claim 1,wherein the external periphery of said body is substantiallycylindrical.
 9. The nail as in claim 8, wherein said nail defines afirst portion having a first diameter and a second portion having asecond diameter, the first diameter being larger than the seconddiameter.
 10. The nail as in claim 9, wherein the first opening and thesecond opening are located in the first portion.
 11. The nail as inclaim 10, wherein said nail further defines a third openingtherethrough, the third opening defining a centerline therethrough. 12.A kit for use in repairing a fracture in a long bone, said kitcomprising: a nail adapted for implantation in a medullary canal of thelong bone, said nail defining a longitudinal axis and an externalperiphery thereof for fitting in the medullary canal of the long bone,said nail having a first internal wall thereof defining a first openingtherethrough, the first opening defining a first opening centerline,said nail having a second internal wall thereof defining a secondopening therethrough, the second opening defining a second openingcenterline, the first opening centerline and the second openingcenterline being oblique with respect to each other, the longitudinalaxis of said body and the first opening centerline forming an acuteangle therebetween and the longitudinal axis of said body and the secondopening centerline forming an acute angle therebetween; a first screwadapted to be slidably fittable with the first opening; and a secondscrew adapted to be slidably fittable with the second opening.
 13. Thekit as in claim 12, wherein at least a portion of said nail iscannulated along the longitudinal axis.
 14. The kit as in claim 12,wherein at least a portion of said nail defines a groove along thelongitudinal axis.
 15. The kit as in claim 12, wherein at least one ofthe first opening and the second opening have a generally cylindricalshape.
 16. The kit as in claim 12, wherein at least one of the firstopening and the second opening have a generally oval shape.
 17. The kitas in claim 12: wherein said nail comprises a third internal walldefining a third opening, the third opening defining a third openingcenterline thereof; and wherein the third opening centerline is normalto the longitudinal axis of said nail.
 18. The kit as in claim 12,wherein at least one of the first opening centerline and the secondopening centerline intersects the longitudinal axis of said nail. 19.The kit as in claim 12, wherein said nail further comprises a internalwall defining a third opening the first opening and the second openinghave a generally cylindrical shape.
 20. The kit as in claim 12, whereinthe external periphery of said nail is substantially cylindrical. 21.The kit as in claim 12, wherein said nail defines a first portion havinga first diameter and a second portion having a second diameter, thefirst diameter being larger than the second diameter.
 22. The kit as inclaim 21, wherein the first opening and the second opening are locatedin the first portion.
 23. The kit as in claim 12, wherein at least oneof said first screw and said second screw is cannulated.
 24. The kit asin claim 12, wherein said nail further comprises internal threads. 25.The kit as in claim 12: wherein said nail comprises a third internalwall defining a third opening, the third opening defining a thirdopening centerline thereof; and wherein the longitudinal axis of saidnail and the third opening centerline define an acute angletherebetween.
 26. The kit as in claim 12, wherein said nail furtherdefines a third opening through said nail.
 27. The kit as in claim 12,wherein said nail further defines a third opening through said nail. 28.A method for performing trauma surgery on a long bone, comprising thesteps of: providing an intramedullary nail, said nail defining alongitudinal axis and an external periphery thereof for fitting in themedullary canal of the long bone, said nail having a first internal wallthereof defining a first opening therethrough, the first openingdefining a first opening centerline, said nail having a second internalwall thereof defining a second opening therethrough, the second openingdefining a second opening centerline, the first opening centerline andthe second opening centerline being oblique with respect to each other,at least one of the first opening centerline and the second openingcenterline being transverse to the longitudinal axis of the nail, thelongitudinal axis of said body and the first opening centerline formingan acute angle therebetween and the longitudinal axis of said body andthe second opening centerline forming an acute angle therebetween;positioning the nail at least partially in the medullary canal;providing a first screw for cooperation with the long bone and forslidable cooperation with the first opening in said nail; inserting saidfirst screw through the cortical wall of the lesser trochanter of thelong bone; inserting said first screw through the first opening;inserting said first screw through the cortical wall of the greatertrochanter of the long bone; providing a second screw for cooperationwith the long bone and for slidable cooperation with the second openingin said nail; inserting said second screw through the cortical wall ofthe long bone; inserting said second screw through the second opening;and inserting said second screw through the cortical wall of the longbone.